There’s a whole host of abnormalities that one can find on POCUS. Some of them do not represent an acute problem. Most of them are of a minor nature and quite common, and do not need further imaging. But in a few cases, follow-up elective imaging is required. Here’s an example.

This elderly patient presented with near-syncope. A battery of tests was ordered at triage, including liver function tests. Most of these results were abnormal, showing a significant elevation compared to three months prior, when the LFTs were within normal limits. The patient was asymptomatic with respect to any gallbladder, liver or other biliary signs or symptoms. Due to the abnormal LFTs, a POCUS scan was done. This was the scan of the patient’s gallbladder.

What do you think? Is this sludge? It could be. But with sludge, you would prefer to see a fluid level/layer in order to confirm its liquid nature. The lumen of this gallbladder is almost completely filled with solid-looking material. It could be solid sludge. But this appearance should cause one to obtain elective imaging to rule out neoplasm. That was done in this case. The elective ultrasound and CT scan did confirm that this was solid sludge. But do not let this dissuade you from obtaining elective imaging to rule out a gallbladder tumour if you see something like this on the screen.